Evidence map›Paper›PMID 26484700›Full record

Trial reportRestorative neurology and neuroscience2015

Stimulation targeting higher motor areas in stroke rehabilitation: A proof-of-concept, randomized, double-blinded placebo-controlled study of effectiveness and underlying mechanisms.

David A Cunningham, Nicole Varnerin, Andre Machado, Corin Bonnett, Daniel Janini, Sarah Roelle, Kelsey Potter-Baker, Vishwanath Sankarasubramanian, Xiaofeng Wang, Guang Yue and 1 more

Registry-linked trialOpen access · greenAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Restorative neurology and neuroscience, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03868410 (A Novel Approach for Brain Stimulation in Severe Stroke), which is not on this map. Cited by 42 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
42citing papers in PubMed, 5 pooled it
4.3field-weighted citation impact, top 6% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03868410 early_phase1completednot on this mapstarted 2019, after this paper: background citation

A Novel Approach for Brain Stimulation in Severe Stroke

TypeinterventionalSponsorThe Cleveland ClinicRan2019 to 2023Enrolled16ConditionsStrokeArmsNew Repetitive Magnetic Stimulation (rTMS) Approach, Conventional Repetitive Magnetic Stimulation (rTMS) Approach
3 · Its place in the literature

Who cites it

42 citing papers in PubMed, 5 syntheses or guidelines pooled it, 71 citations in OpenAlex.

  1. Pooled it
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  3. The modulatory effects of bilateral arm training (BAT) on the brain in stroke patients: a systematic review.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2021
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  11. Inhibition versus facilitation of contralesional motor cortices in stroke: Deriving a model to tailor brain stimulation.Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology · 2017
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  13. Review
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  17. Neurostimulation After Stroke.Physical medicine and rehabilitation clinics of North America · 2024
    Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 4 institutions in 1 country.

David A CunninghamDepartment of Biomedical Engineering, Lerner Research Inst., Cleveland Clinic, Cleveland, OH, USA.
Nicole VarnerinDepartment of Biomedical Engineering, Lerner Research Inst., Cleveland Clinic, Cleveland, OH, USA.
Andre MachadoCenter for Neurological Restoration, Neurosurgery, Neurological Inst., Cleveland Clinic, Cleveland, OH, USA.
Corin BonnettDepartment of Biomedical Engineering, Lerner Research Inst., Cleveland Clinic, Cleveland, OH, USA.
Daniel JaniniDepartment of Biomedical Engineering, Lerner Research Inst., Cleveland Clinic, Cleveland, OH, USA.
Sarah RoelleDepartment of Biomedical Engineering, Lerner Research Inst., Cleveland Clinic, Cleveland, OH, USA.
Kelsey Potter-BakerDepartment of Biomedical Engineering, Lerner Research Inst., Cleveland Clinic, Cleveland, OH, USA.
Vishwanath SankarasubramanianDepartment of Biomedical Engineering, Lerner Research Inst., Cleveland Clinic, Cleveland, OH, USA.
Xiaofeng WangDepartment of Quantitative Health Sciences, Cleveland Clinic, OH, USA.
Guang YueHuman Performance & Engineering Laboratory, Kessler Foundation Research Center, West Orange, NJ, USA.
Ela B PlowDepartment of Biomedical Engineering, Lerner Research Inst., Cleveland Clinic, Cleveland, OH, USA.
Cleveland Clinic Lerner College of Medicine · USCleveland Clinic · USKessler Foundation · USThe Neurological Institute · US

Funding

Clinical and Translational Science Collaborative of ClevelandUL1TR000439 · NCATS · CASE WESTERN RESERVE UNIVERSITY · PI KONSTAN, MICHAEL W. · 2012 to 2016
$50.0M
Brain Stimulation- aided Stroke Rehabilitation: Neural Mechanisms of RecoveryK01HD069504 · NICHD · CLEVELAND CLINIC LERNER COM-CWRU · PI PLOW, ELA B · 2011 to 2015
$531k
NCATS NIH HHS UL1 TR000439NICHD NIH HHS 1K01HD069504NICHD NIH HHS K01 HD069504
6 · The paper itself

Abstract

purposeTo demonstrate, in a proof-of-concept study, whether potentiating ipsilesional higher motor areas (premotor cortex and supplementary motor area) augments and accelerates recovery associated with constraint induced movement.

methodsIn a randomized, double-blinded pilot clinical study, 12 patients with chronic stroke were assigned to receive anodal transcranial direct current stimulation (tDCS) (n = 6) or sham (n = 6) to the ipsilesional higher motor areas during constraint-induced movement therapy. We assessed functional and neurophysiologic outcomes before and after 5 weeks of therapy.

resultsOnly patients receiving tDCS demonstrated gains in function and dexterity. Gains were accompanied by an increase in excitability of the contralesional rather than the ipsilesional hemisphere.

conclusionsOur proof-of-concept study provides early evidence that stimulating higher motor areas can help recruit the contralesional hemisphere in an adaptive role in cases of greater ipsilesional injury. Whether this early evidence of promise translates to remarkable gains in functional recovery compared to existing approaches of stimulation remains to be confirmed in large-scale clinical studies that can reasonably dissociate stimulation of higher motor areas from that of the traditional primary motor cortices.

Indexed as

Stroke RehabilitationAgedDouble-Blind MethodFemaleFunctional LateralityHumansMagnetic Resonance ImagingMaleMiddle AgedMotor CortexMotor SkillsMusculoskeletal ManipulationsPilot ProjectsPrognosisRecovery of FunctionStrokeconstraint-induced movement therapymotor recoverypremotor cortexStroke rehabilitationtranscranial direct current stimulationtranscranial magnetic stimulation

Identifiers

PMID26484700
PMCPMC4732280
OpenAlexW2176659382

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.